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Towards improved Reproductive Health: the challenges of unsafe abortion

Towards improved Reproductive Health: the challenges of unsafe abortion. A special guest speaker presentation at the 3 rd Scientific Conference of KNUST College of Health Sciences. Kumasi, 26-27 August 2010. By Professor K. A. Danso Dean, KNUST School of Medical Sciences, Kumasi.

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Towards improved Reproductive Health: the challenges of unsafe abortion

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  1. Towards improved Reproductive Health: the challenges of unsafe abortion A special guest speaker presentation at the 3rd Scientific Conference of KNUST College of Health Sciences. Kumasi, 26-27 August 2010. By Professor K. A. Danso Dean, KNUST School of Medical Sciences, Kumasi.

  2. Introduction • The invitation • Presentation on a‘topic in your area of specialisation relating to the theme of the conference.’: • R & CH: current trends and challenges. • Path to selection of my topic • Conference theme • Concerns for maternal health (a key component of RH) • Concerns for the impact of unsafe abortion (a controversial women’s health issue since primitive times) • My research interests in unsafe abortion

  3. Towards improved RH: the challenges of unsafe abortion • The roadmap of presentation • Overview of RH • Definition • Key objectives of RH • Significance of RH • Discuss the challenges • The burden • Legislation and Policy • Socio-cultural issues • Strategies for intervention

  4. RH defined (ICPD 1994) • The state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes.

  5. RH seeks to ensure (ICPD 1994 Prog of Action Para 7.2) • Safe and satisfying sex life • Capability to reproduce and freedom to reproductive decisions • Information and access to safe, effective, affordable and acceptable contraceptives • Right of access to appropriate health care services for women to go safely through pregnancy and childbirth (MATERNAL HEALTH) • Best chance of having a healthy infant (CHILD HEALTH)

  6. Significance RH • Represents a major contribution to general health, sustainable socio-economic development and poverty reduction • Has recognition in UN action agenda (the MDGs) with specific goals on maternal and child health • MDG 4 improve child health • MDG 5 improve maternal health

  7. Several strategic interventions at the national and global fronts to improve RH • Safe motherhood and newborn care • Providing high quality FP services • Combating STIs, HIV and reproductive tract cancers • Promoting sexual health, responsible behaviour and parenthood • Eliminating unsafe abortion

  8. Direct causes of maternal deaths worldwide (PRB 2006) • Severe bleeding 25% • Infection 15% • Unsafe abortion 13% • Hypertensive disorders 12% • Obstructed labour 8% • Others 8% • Developing countries’ figures for unsafe abortion are much higher than the global figure; may reach 50% in some Sub-Saharan African countries

  9. Unsafe abortion is thus a major public health challenge to RH, especially in developing countries. • Unsafe abortion defined: • “a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both” (WHO) • A safe termination of pregnancy is safer than a vaginal delivery.

  10. Challenges of unsafe abortion I: THE BURDEN • Developing countries unsafe abortion figures > global estimate > > in developed countries • In developing countries • many more lives are lost • chronic disability occurs • drain on scarce health budget

  11. Annual incidence of Unsafe abortion and maternal deaths from Unsafe abortion (WHO 2004)

  12. Unsafe abortion in Ghana • 22-30% of maternal deaths (GHS) (2006) • MMR 451(MHS, 2007); 540 (UNFPA) per 100,000 live births • KATH (Konney, Danso et al, Nov 2009) • Attitude of women with abortion related complications towards provision of safe abortion services in Ghana • 42.7% (n= 296 GYN admissions) with abortion related complications • 28% reported induced abortion

  13. Challenges of unsafe abortion II: LEGISLATION AND POLICY • Legal status of abortion is a determinant to its safety, affordability and accessibility • Regardless of the legal status, induced abortions occur • The more restrictive the law, the higher the extent of unsafe abortions, injuries and maternal deaths • Where abortion is legal • likely to be done by skilled person, more available and costs less • unskilled backstreet providers are eliminated • Death rate from safe, legal induced abortion (USA) < 1 per 100,000 procedures (PRB 2006) • Cf 650 deaths per 100,000 unsafe abortion Africa.

  14. Abortion laws worldwide falls into 5 categories from the most to least restrictive • Permitted only to save woman’s life • Angola, Cote d’Ivoire, Egypt, Libya. Niger, Nigeria, Sudan • Permitted to protect woman’s life and physical health • Eg Benin, Burkina Faso, Ethiopia, Guinea, Zimbabwe • Permitted to protect woman’s life, physical and mental healthEg. Algeria, Botswana, Gambia, Ghana, Liberia • Permitted to protect woman’s life, physical and mental health and on socioeconomic grounds • Eg Zambia • Without restriction as to reasonEg Cape Verde, S. Africa, Tunisia

  15. Even where abortion is legally permitted, services may not be available to the extent of the law due to • Lack of trained personnel • No provision of service in national health facilities • Unwilling providers: individual values, stigma • Lack of knowledge of the law • KATH (Konney, Danso et al, Nov 2009) • Attitude of women with abortion related complications towards provision of safe abortion services in Ghana • 92% unaware of legal status of abortion in Ghana but they thought there was the need to provide safe abortion services and almost all of them were willing to patronise such services.

  16. Attitude of doctors towards establishing safe abortion units in Ghana: 2007 ESK Morhe, RAS Morhe, KA Danso • To assess physician knowledge of abortion law, proportion in favour of safe abortion units and those willing to offer services (KATH, n =74) • 98% permitted (for various reasons) • 2% strictly illegal • 80% favoured safe abortion units • 36% will do counselling only • 45% will perform procedure • 19% will play no role in unit

  17. Challenges of unsafe abortion III: SOCIAL OPINION • Culture of silence and mixed opinion toward safe abortion services as intervention for unsafe abortion • Supportive • Indifference • Hostility • Generates controversy and inflames passion • Sensitive, divisive, contentious • Moral, ethical, religious, cultural, political • These overshadow the public health impact • High toll on women’s life • Chronic irreversible morbidity • Drain of health resources

  18. Unsafe abortion is a threat. Interventions are needed to improve RH • Basis of intervention: Unsafe abortion preventable • Public education, advocacy and research: to better understand the burden, strategic approaches • Family Planning services: eliminating unmet need (34%), preventing unwanted pregnancy • Safe abortion services within the context of the law: policy changes, avoiding unsafe abortions • Training of service providers: FP and CAC for maternal health improvement (IFPFP Ghana).

  19. THANK YOU

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